Access to treatment of acute hepatitis b and chronic hepatitis b acute exacerbation

Objectives: Acute hepatitis B (AHB) and chronic hepatitis B acute exacerbation (CHBAE) can lead to liver failure, necessitating careful monitoring and urgent intervention. This study aimed to evaluate patients diagnosed with AHB and CHBAE, the antivirals initiated, and the methods of accessing these treatments. Materials and Methods: This study included patients monitored at our hospital over a 5 year period with diagnoses of AHB and CHBAE. Clinical symptoms of the patients, potential etiologies leading to infection or exacerbation, laboratory values, possible diagnoses, indications for antiviral treatment, methods of treatment access, and disease course were retrospectively evaluated. Results: Seven patients diagnosed with AHB and 12 with CHBAE were included in the study. Antiviral therapy was initiated in nine patients (47.4%). Among these patients, four began antivirals for coagulopathy, one for pregnancy, one for cessation of previously used antivirals for CHB, and three for ongoing liver function test abnormalities and hepatitis B virus-DNA positivity. Only two patients had swift access to treatment through health insurance coverage, while others pursued alternative routes, such as off-label drug approval. None of the patients developed fulminant hepatitis. Conclusion: The treatment indications for AHB are clearly established based on the guidelines. Some studies recommend initiating treatment for all CHBAE cases, whereas others suggest treatment only when signs of liver failure are present. Access to treatment for patients who require urgent intervention may be delayed due to non-compliance with healthcare reimbursement regulations. Adjustments in health insurance coverage for antiviral therapies are necessary to mitigate such delays

Predicting mechanical ventilation, intensive care unit admission, and mortality in COVID-19 patients: Comparison of seven different scoring systems

Objective: In this study, we investigated whether scoring systems determine coronavirus disease-2019 (COVID-19) severity. Materials and Methods: COVID-19 patients hospitalized between 01.09.2020 and 31.04.2021 were retrospectively assessed. The national early warning score (NEWS), modified early warning score, rapid emergency medicine score, quick sequential organ failure assessment score (q-SOFA), CURB65, MuLBSTA, and ISARIC-4C scores on admission day were calculated. Scoring systems' ability to predict mechanical ventilation (MV) need, intensive care unit (ICU) admission, and 30-day mortality were assessed. Results: A total of 292 patients were included; 137 (46.9%) were female, and the mean age was 62.5 +/- 15.4 years. 69 (23.6%) patients required ICU admission, 45 (15.4%) needed MV, and 49 (16.8%) died within 30 days. No relationship was found between q-SOFA and MV need (p=0.167), but a statistically significant relationship was found between other scoring systems and MV need, ICU admission, and 30-day mortality (p5.5) and NEWS (optimal cut-off >3.5) had the highest area under the curve in receiver operating characteristic curve analyses, whereas q-SOFA had the lowest. Conclusion: The severity of COVID-19 could be estimated by using these scoring systems, especially ISARIC-4C and NEWS, at the first admission. Thus, mortality and morbidity would be reduced by making the necessary interventions earlier. Keywords: COVID-19, ISARIC-4C, mortality, NEWS, scoring system

The Effect of Clinical, Laboratory and Radiological Findings on Mortality in Patients with Severe COVID-19

Introduction: COVID-19 can range from asymptomatic to critical illness and may result in mortality. In our study, we aimed to evaluate the effect of clinical, laboratory, and radiological findings on mortality in patients diagnosed with severe COVID-19. Materials and Methods: We included SARS-CoV-2 polymerase chain reaction (PCR) positive patients followed up in infectious diseases pandemic and chest diseases pandemic departments at Rize State Hospital in 01.01.2020-31.03.2021. Epidemiological data, chronic diseases, admission symptoms, laboratory findings, and radiological findings of the patients were recorded retrospectively from the patient files. Patients were grouped as survivors and non-survivors. We defined severe disease as patients with pneumonia on radiological imaging, oxygen saturation < 0.05. Results: 135 patients, 110 of whom were survivors and 25 non-survivors, were included in the study. The mean age was 65.5 ± 15.45 years and 61.5% (n= 83) of patients were male. The mean age of the non-survivors was higher compared to survivors (p= 0.007). The mortality rates in patients with coronary artery disease (CAD) and chronic kidney disease (CKD) were statistically higher in non-survivors (p= 0.032, p= 0.032). The rate of tachypnea was found to be statistically higher in the non-survivors (p= 0.001). During the follow-up period, chest X-rays were taken every other day for assessment. The rate of progression was found to be statistically significantly higher in non-survivors (p= 0.004). According to the results of the multivariate logistic regression analysis, the presence of CAD, tachypnea at hospital admission, and progression in chest X-ray were considered independent risk factors for mortality. Conclusion: In this study, the factors that may worsen the disease in the severe COVID-19 disease course were estimated and the presence of CAD, tachypnea, and progression in chest X-ray was found to be independent risk factors for mortality. In addition to chronic diseases and symptoms at presentation, the detection of progression in chest X-ray in the clinical follow-up of patients is a risk factor for mortality, which shows us that radiological follow-up should be kept in mind during the course of the disease

Attitude of healthcare workers towards COVID-19 vaccination at a university hospital

Introduction: Vaccination is one of the preventive measures that should be taken against COVID-19. In this study, we aimed to evaluate the COVID-19 vaccination status and factors affecting vaccination of healthcare workers (HCWs) working in our hospital. Methods: This cross-sectional study was conducted by filling out a questionnaire form with face-to-face or snowball methods to HCWs in our hospital. The questionnaire is composed of 10 questions, including demographic information, occupation of the person, working in the pandemic unit, COVID-19 and Influenza vaccination information, contracting COVID-19, and hospitalization status. Full-dose vaccination was defined as four doses in total. P[removed